Organization
SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.
Active
Other names
Guardian Care 1, 2, 3, 4, Changing Lives, Safe Haven,Bridge of Hope
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HELEN DELORISE FLUDD (CEO)
(910) 382-6595
Entity
Organization
Contact information
Practice address
123 HENDERSON DR, JACKSONVILLE, NC 28540-5601
(910) 939-4663
(910) 939-5079
Mailing address
PO BOX 752, JACKSONVILLE, NC 28541-0752
(910) 939-4663
(910) 939-5079
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
311ZA0620X
Adult Care Home Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
MHL-067-164
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001GM
BLUE CROSS BLUE SHIELD
NC
01
—
009EJ
BLUE CROSS BLUE SHIELD
NC
05
—
3408311
—
NC
05
—
3418119
—
NC
05
—
6006360
—
NC
05
—
6601227
—
NC
05
—
6602173
—
NC
05
—
7805061
—
NC
05
—
8301352
—
NC
05
—
8301352B
—
NC
05
—
8301352G
—
NC
Enumeration date
03/14/2007
Last updated
02/02/2015
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